MEDICARE: STAKS ENTERPRISES LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	309	NV

General Provider Information

NPI Number	:	1508103516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAKS ENTERPRISES LLC.

Provider Business Mailing Address
First Line	:	PO BOX 36252
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6252
Country	:	US
Telephone Number	:	702-456-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 W LAKE MEAD BLVD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0299
Country	:	US
Telephone Number	:	702-456-0002
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ALICE PENELOPE MOLONEY
Credential	:
Telephone Number	:	702-456-0002

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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Directions to “STAKS ENTERPRISES LLC. ” Practice Location

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